Medicare Open Enrollment – It’s That Time Again!

Here are the six Medicare questions I hear the most, along with some suggestions regarding how to make sense of it all:

  1. Why am I suddenly receiving so much marketing information in the mail?

    If you or a loved one are approaching 65, expect to be inundated with marketing materials regarding the multitude of products surrounding Medicare options offered by private insurance companies. Most will encourage you to enroll in one of their Medicare Advantage plans (i.e., “Medicare Part C”).

    What most people don’t realize, however, is how these plans fit into the overall Medicare picture or, how a choice you make when initially enrolling in Medicare can have long-term implications.

    That’s why I recommend first educating yourself about Medicare at the web site. It’s important that you understand the Medicare Alphabet Soup before embarking on any particular plan.

  1. When do I enroll in Medicare?

    There’s a specific window of time within which you must enroll in Medicare, so as not to incur a financial penalty in the future. When you’re first eligible for Medicare (i.e., when you turn 65), you have a seven month Initial Enrollment Period to sign up for Part A and/or Part B. The seven months cover the period three months before you turn 65, the month you turn 65 and three months after you turn 65.

    I encourage everyone turning 65 to enroll in Medicare Part A as soon as possible – even if you have plans to continue working. This way, you will obtain your Medicare card and Medicare ID number. The number is necessary to enroll in other Medicare products and, since there is no associated premium for Part A, this is a good starting point.

    Whether or not you enroll in Part B requires some consideration. First, because there is an associated premium that is calculated based on your Modified Adjusted Gross Income (MAGI) from two years earlier. Second, if you intend to remain working and have an employer-sponsored group plan on which you can remain, or you obtain your coverage through a spouse’s family plan, this decision may be deferred to another time. Here’s where things begin to get complicated.

  1. How do I enroll in Medicare?

    You enroll in Medicare through Social Security – even if you plan to continue working and do not plan to start receiving retirement benefits for some time. Medicare enrollment in Part A can occur using an online application that makes the process fairly easy and precludes you from having to spend hours in a Social Security office. In most cases, once your application is submitted electronically, you’re done. There are no forms to sign and usually no documentation required.

    Even so, pay attention to your mail because Social Security will process your application and contact you if more information is needed. If you ignore this request, delays and complications can occur. If no additional information is needed, you’ll receive your Medicare card in the mail.

    If you’ve enrolled in Medicare Part A and, later on, must enroll in Part B, you must call Social Security or contact the local office (you can’t sign up for Medicare Part B online). Again, as you are doing all of this, pay close attention to your mail, especially if you are in a higher income bracket. Such correspondence will provide information about “income adjustments” that will be assessed on your Part B and Part D premiums once you enroll in these benefits. Information from Social Security about “Income Adjustments” to Medicare Part B and Part D is available online.

  1. What about my spouse and children?

    When enrolling in Medicare, it is important to consider the needs of your spouse and dependent children. If you’ve provided health insurance to your family through an employer-sponsored group plan that you’ll no longer be enrolled in, each family member’s needs must be considered individually, as different options may exist depending on employment status, accessibility to another employer-sponsored plan, age, whether someone is a student, etc.
  1. What if I intend to remain employed?

    If you intend to remain employed, enroll in Part A but be thoughtful about enrolling in Part B. The need to do this right away will depend on the size of your employer, specific human resource policies of your employer and specific Medicare regulations about who pays first. Again, careful consideration must be made and an action plan developed that considers you and each of your family members.
  1. What should I choose?

    Not surprisingly, the best choice from among the multitude of options available depends upon your specific circumstances and preferences regarding how you like to access care.

    Questions I recommend asking include:

    • What is the status of your health and how often during a year do you access care?
    • Do you anticipate any health-related issues, hospitalizations or surgeries in the coming year?
    • Who are your physicians and what is your preferred hospital?
    • Do you want a managed care plan such as an HMO or PPO in which you might be restricted to specific networks of doctors and referrals and prior authorizations must be obtained before you can receive care?
    • Do you plan to travel and possibly reside outside of your current state for long periods of time during the year?

    Your answer to these questions (and others) will have an impact on your “best choice,” so consider them carefully and apply them to the programs you may be considering.

Whew! A lot to consider, I know. That’s why my most important recommendation is that you educate yourself. Learn what you can, ask lots of questions and please be in touch if you need some assistance.